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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES ' 1
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
t
Builder's
2. / License No.
Contractor I
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Si ature of ppli t Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned Number By Permit or Approval Check Obtained Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 ilC
Building Fire Grading
Permit Fee $ l - �' Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ _
Plan Review Fee $ r: � •, t
— TITLE
NOTES and Data — (For department use) -
"� 1
Ile
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT�— Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
(•
ZONING
AT (LOCATION) �`'� p ,1
/�.Pn �„{ ,t.� � � DISTRICT _
LOCATION �R�) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
m
1 ❑ New building Reside tiol Nonresidential
2 Addition(1 residential, enter number
❑ J 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
Alteration (See 2 above)
3
number of units— — — — � 20❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ parking garage
4 Repair, replacement or dormitory — Enter number
5 F-1 Wrecking (If multifamily residential, o f units ——————— — -jo 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement••,••••,••••,... school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
it. TOTAL COST OF IMPROVEMENT $ 3
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30❑ Masonry (wall bearing) 40L5m�Public or private company 48• Number of stories...............
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet n floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34[__1 Other — Specify 42�Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MiCHANICAL 51. Enclosed .......................
35❑ Gas Will there be cert{al air 52. Outdoors........................
36, 'OiI conditioning? `
,1 L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45Q No 53. Number o drooms............
38 ❑ Coal �n 13-T f 41 fi-.'
39❑ Other — Specify Will there be an,elevator? Full........^.
54. Number of
46 ❑ Y 47[::] No bathrooms
Partial.......
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LLB;
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hereby certify that the ¢roposed' work is authorized by the owner of rec$rd
and 1 have been authorized by the owner to make this application as '.leis -
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ZO
222 MAIN STREET BUILDING aQ
NOR.THAMNTON, MA, 01060 PERMIT
29 - 463 CODE #79 R VALIDATION
DATE February 11 - 19 RO PERMIT NO. 7�
APPLICANT Jaime Rodriguez ADDRESS 34 Crestview Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO sI teratioxt (.2_) STORY bedrtXOms & batkt DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 39 rro stview Drtyp DISTRICT
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
a. LOT
m SUBDIVISION LOT BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
a
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
K
O
REMARKS: t'1I.++.Rw'Fh US siprta4 rc, to Maly,*1'X beArGOMS-annd 1 ft^i 1 biath
2 X 4 studs 16 o.c.
AREA OR s
VOLUME ESTIMATED COST FEEMIT 10!00
(CUBIC/SQUARE FEET)
OWNER jaime Rodrigno7
BUIL ING PT
ADDRESS 34 (`re$tYieS nrrive, Nnrthamnton, Mao, BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)